Do adults in contact with Australia's public sector mental health services get better?

This paper describes the outcomes of episodes of care for adults in public sector mental health services across Australia, with a view to informing the debate on service quality. Health of the Nation Outcome Scales (HoNOS) change scores and effect sizes were calculated for 14,659 acute inpatient episodes and 23,692 community episodes. The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type. This confirmatory finding is particularly positive, given current community concerns about the quality and effectiveness of mental health services.     

Isolation of low-frequency class-switch variants from rat hybrid myelomas

Class-switch variants have been isolated from rat-rat hybrid myelomas by sib selection using a simple assay based on red cell-labelled antiglobulins. The variants detected are consistent with the gene order deduced from molecular cloning. They appear to arise spontaneously at a rate approximately ten-fold lower than for mouse cell lines but the rate of switching back to the parental isotype is substantial in comparison. An IgG2b variant antibody having the same specificity as CAMPATH-1 for human lymphocytes and monocytes is active in antibody-dependent cell-mediated killing (unlike the parental IgG2a) and may prove to be a valuable therapeutic antibody for immunosuppression and treatment of leukaemia and lymphoma.     

Comparison of assays to detect cytomegalovirus shedding in the semen of HIV-infected men

We sought to determine the optimal assays for cytomegalovirus (CMV) shedding in semen. Over a 2-month period, 149 HIV-1-infected men who have sex with men each provided up to three semen specimens. Specimens were tested for CMV by culture, rapid assay (shell vial) and polymerase chain reaction (PCR). By culture, 30% of seminal plasma and 28% of seminal cell specimens grew CMV. By rapid assay, results were 38 and 33%, respectively. By PCR, 56% of seminal cell specimens demonstrated CMV: 20% in a single semen specimen; 33% in two specimens; and 34% in all three specimens. Overall, 69% of men had CMV detected by PCR in at least one seminal cell specimen. By quantitative PCR, 14% had ten, 14% had 100, 16% had 1000, and 12% had 10 000 copies in 6.25 μl of semen analyzed. Adjusting for initial CD4+ cell count, men with CMV shedding demonstrated by PCR at the first visit were approximately four times as likely to shed CMV at a subsequent visit (RR 4.28, CI: 2.30–7.95). CMV shedding was associated with decreased CD4+ cell counts in peripheral blood (P=0.05). It is concluded that the PCR assay provided the greatest sensitivity among the three detection methods.     

The coagglutination phenomenon of Bordet and Gengou involves a reaction between antibody-aggregated fourth component of complement and a receptor on guniea pig red cells

The coagglutination phenomenon of Bordet and Gengou has been re-investigated. Many of the original observations have been confirmed. However, the explanation of the phenomenon has been found to be more special than that offered by Bordet and Gengou, who envisaged 'entrainment; or enmeshment of guinea pig red cells by lattices formed by antibodies reacting with serum proteins. We found that, so far as human serum is concerned, coagglutination of guinea pig red cells is confined to an activity of the fourth component of complement following its reaction with antibody. The nature of the association between antibody-reacted or antibody-aggregated C4 and the receptor on the guinea pig red cells is still to be elucidated.     

Direct antibody rosette-forming reactions using monoclonal markers of lymphocyte subpopulations. Methodology and applications illustrated by investigations with rat pan-T antibodies of the CAMPATH series

A sensitive direct antibody rosette assay has been developed for the detection of antigens on the lymphocyte cell membrane. Indicator cells for rosette tests were prepared by chromic chloride coupling of rat or mouse monoclonal IgG or IgM anti-lymphocyte antibodies to untreated or trypsinized bovine red blood cells. The monoclonal antibodies used were reactive with a range of cell surface markers which identify various lymphocyte subpopulations, including T cell antigens, HLA class II (Ia-like antigens), Leu-7 (HNK-1) and VEP 13, a determinant of Fc gamma receptors on large granular lymphocytes. Results obtained by direct rosette formation correlated well with those of parallel tests using indirect immunofluorescent antibodies staining. Several applications of the direct antibody rosetting procedure are described in further investigations with a series of pan-T monoclonal (CAMPATH) antibodies. These include the morphological examination of antibody-binding cells in cytocentrifuge smears, the separation of lymphocyte subsets by density gradient centrifugation, and the use of a rosette inhibition assay to identify monoclonal antibodies binding to the same (or closely associated) epitopes of the lymphocyte cell membrane.     

Factors which govern the sensitivity of direct and indirect rosetting reactions and reverse passive haemagglutination in the identification of cell surface and free macromolecules

A series of immunoassays have recently been elaborated in which the red cell is used as a label or marker of interacting antibody, often anti-immunoglobulin (anti-Ig). This paper considers and investigates quantifiably, the different variables which affect the sensitivity of direct and indirect antiglobulin rosetting reactions (DARR and IARR) and of reverse passive haemagglutination (RPH).

Sensitivity is governed by the surface properties and amount of antibody on the indicator red cell and, in detection of cell-bound antigen, by the antigen density. By varying the antibody:Ig ratio on the red cell using affinity purified anti-Ig, cells with more than 1:32–64 antibody:Ig showed similar sensitivity in detection of lymphocyte sIg in DARR and IARR tests and of serum Ig by RPH. Using these indicator cells coupled with different Ab:Ig ratios to detect lymphocytes sensitized with different levels of anti-Ig in a model IARR test, it was clear that studying cells with a high density of determinants on the lymphocyte surface it is not necessary to have `strong' anti-immunoglobulin on the indicator cell, but increasingly sparse determinants require increasingly strong anti-Ig on the red cell to detect all positively reacting cells.

Red cells of different species afford carriers of varing sensitivity in all three reactions—DARR, IARR and RPH. Preliminary trypsin treatment may greatly further enhance the sensitivity of some species red blood cells (e.g. bovine and sheep), but leaves others (e.g. pig and donkey) unchanged. Use of ¹²⁵I-labelled Ig and anti-Ig showed that the increased sensitivity of trypsinized bovine and sheep RBC is not due to increased uptake of Ig during chromic chloride linkage or of antibody in agglutinations.

     

Rotational moulding in the production of prostheses

This paper discusses the place of rotational moulding in the provision of prosthetic shanks and shank sections. It covers the selection of thermoplastic material, the moulding conditions and their automation in a machine process, and the development of a suitable range of moulds. Also covered is the question of interfacing between the moulded shank sections and other limb components, fatigue strength as tested to date and early results of patient field trials. The most developed of the possible prosthetic options available consists of a hollow tapered column having inserts at each end by which it is clamped through alignment couplings to the socket and foot respectively. For a below-knee application, the complete tapered column prosthesis weighs typically 1 kg. Static and fatigue testing of representative samples by the simultaneous application of compressive and bending loads to the maximum values specified by international standards exposed no failures by the time a million cycles had been reached. This method of fabrication has the merit of being capable of implementation locally on an "as required" basis. Additional advantages include the low cost of the mould tooling and the flexibility to mould a variety of shapes. Prosthetic feet are a possibility as are special shoes and orthotic parts. These may require other materials and experimentation is proceeding using structural and resilient foams.     

Proteome analysis of Helicobacter pylori: major proteins of type strain NCTC 11637

Proteome analysis involves the simultaneous resolution and display of proteins produced by an organism, followed by the quantitation, characterisation and identification of these proteins. As part of an ongoing study mapping and comparing the proteins expressed by various strains of the pathogenic bacterium Helicobacter pylori, we have resolved and identified 93 of the most abundant proteins expressed by type reference strain NCTC 11637. Proteins were separated by two-dimensional gel electrophoresis and stained with Coomassie G250. Intensely-stained spots were excised and digested with trypsin, and the resulting peptides were characterised by mass spectrometry. Proteins were then identified by correlating actual peptide profiles with theoretical profiles generated from published nucleotide sequences. Ninety-three of the most intensely-stained protein spots were identified as the products of 35 genes, giving a ratio of 2.7 protein gene-products per gene. The products of the tsaA, pfr, ureA and ureB genes were amongst several proteins present in multiple isoforms. Peptide mass fingerprinting data were used to identify probable post-translational protein modifications. These results suggest that H. pylori proteins are subject to a high degree of post-translational modification. Comparative proteomics of H. pylori strains should greatly assist in investigating the pathogenic properties of this bacterium.     

Factors affecting the level of success of community information systems

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. However, previous research has rarely targeted different instances of a common type of system within a homogeneous organisational sector. This paper presents the results of a survey of IM&T managers within Community Trusts to gain insights into the factors affecting the success of Community Information Systems. The results demonstrate that the most successful operational systems were thoroughly tested prior to implementation and enjoyed high levels of user and senior management commitment. Furthermore, it has been shown that there is a relationship between the level of organisational impact and systems success, with the most successful systems engendering changes to the host organisation's culture, level of empowerment and clinical working practices. In addition to being of academic interest, this research provides many important insights for practising IM&T managers.